Persistent racial and ethnic disparities in up-to-date colorectal cancer testing in medicare enrollees

J Am Geriatr Soc. 2009 Mar;57(3):412-8. doi: 10.1111/j.1532-5415.2008.02143.x. Epub 2009 Jan 16.

Abstract

Objectives: To assess whether greater colonoscopy use among white as compared with nonwhite Medicare enrollees since Medicare established coverage for colorectal cancer (CRC) screening has been associated with a widening in white versus nonwhite disparities in up-to-date CRC testing status.

Design: Serial cross-sectional analysis of Medicare claims.

Setting: Surveillance, Epidemiology, and End Results (SEER) regions in nine states, representing 14% of the U.S. population.

Participants: A 5% random sample of fee-for-service Medicare enrollees aged 70 to 79 within each 6-month period from mid-1995 through 2003.

Measurements: Trends in up-to-date status (having a fecal occult blood test (FOBT) claim in the prior year or a sigmoidoscopy or colonoscopy claim in the prior 5 years) according to race or ethnicity, estimated using repeated-measures logistic regression adjusting for age, sex, rural versus urban residence, income, comorbidity, and SEER region.

Results: From mid-1995 through 2003, the adjusted percentage of enrollees that were up-to-date increased by a similar magnitude in whites (from 39.4% to 47.3%), blacks (from 29.0% to 38.1%), Asians and Pacific Islanders (from 33.1% to 41.8%), and Hispanics (from 23.7% to 33.2%). Although white versus nonwhite disparities in up-to-date status via colonoscopy widened, this was counterbalanced by narrowing white versus nonwhite disparities in up-to-date status via FOBT and sigmoidoscopy.

Conclusion: White versus nonwhite disparities in up-to-date CRC testing status in Medicare enrollees largely persisted through 2003.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Continental Ancestry Group / statistics & numerical data*
  • Aged
  • Asian Americans / statistics & numerical data*
  • Colonoscopy / statistics & numerical data*
  • Colorectal Neoplasms / ethnology*
  • Colorectal Neoplasms / prevention & control
  • Cross-Sectional Studies
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Medicare / statistics & numerical data*
  • Occult Blood*
  • Rural Population / statistics & numerical data
  • Sigmoidoscopy / statistics & numerical data*
  • Socioeconomic Factors
  • United States
  • Urban Population / statistics & numerical data
  • Utilization Review / statistics & numerical data